CPAPtalk.com

Posted: **Sun Mar 29, 2009 7:26 pm**

Please don't take ordinary spirited conversation to heart, GerryK. I assumed you were a clinician until your post immediately prior. Now that I know you're an EMT, your part of the thread reads a little differently to me.

SAG runs a sleep center up in one of the Northeastern states. Rumor has it that wasn't his first choice, though. Apparently he first petitioned for admission into the state of Illinois----but sadly never managed to produce the necessary Midwestern accent. Anyway, if "Illinois Envy" isn't a Freudian term maybe it should be.

Posted: **Sun Mar 29, 2009 7:55 pm**

-SWS wrote: . . . accent. . . "Illinois Envy" . . . Freudian term . . . .

Here in Brooklyn, the shrinks pronounce the "S" in Illinois.

Posted: **Sun Mar 29, 2009 8:05 pm**

jnk wrote:
-SWS wrote: . . . accent. . . "Illinois Envy" . . . Freudian term . . . .
Here in Brooklyn, the shrinks pronounce the "S" in Illinois.

...And ironically most of our state is mind-numbingly quiet.

Posted: **Sun Mar 29, 2009 8:08 pm**

Our state is somewhat quiet but our ex governor is now on talk radio.

Posted: **Sun Mar 29, 2009 8:12 pm**

Gerryk wrote:Our state is somewhat quiet but our ex governor is now on talk radio.

Oh yeah... I forgot that I was denying I'm from Illinois.

Sincerely,
The Politically Concerned Hoosier Next Door

Posted: **Mon Mar 30, 2009 5:25 am**

Gerryk wrote:Still another guest You know, I asked if you were a rep but you never answered.

Actually, you didn't ask, you decided that:

Gerryk wrote:You must sell medical equipment those are the only people I have ever met suggest throwing away something that works.

However, as noted

-SWS wrote:SAG runs a sleep center up in one of the Northeastern states.

Further, had you done a little research, you would have discovered that I am also an RCIS, which makes me a card-carrying member of a PAMI Team, who, interestingly, helped install the Lifenet RS System for remote data transmission.

Gerryk wrote:I still haven't heard what you do that you are so knowledgeable.

Please speak up and teach us all.

I don't believe you are interested in learning anything.

SAG

Posted: **Mon Mar 30, 2009 6:35 am**

SAG wrote:RCIS, which makes me a card-carrying member of a PAMI Team, who, interestingly, helped install the Lifenet RS System for remote data transmission.

As it turns out I didn't forget about your RCIS qualification, but failed to mention it. However, I didn't realize that you had helped install the Lifenet RS System for remote data transmission, which I personally find very interesting---and relevant.

For newcomers: StillAnotherGuest has been kind enough to share his considerable knowledge and experience throughout the years on this and other message boards (a.k.a. "sleepydave"). I have personally learned a lot from him, as have very many others. I would like to take this opportunity to thank Dave for all that he has shared throughout the years---as I am of the opinion that he has saved lives on the message boards as well as in his daily work.

Thank you very much, SAG.

Posted: **Mon Mar 30, 2009 6:51 am**

You must sell medical equipment those are the only people I have ever met suggest throwing away something that works. If it aint broke don't fix it.[/quote]

All this started because I said oxygen bottle and not cylinder.

This is off the Medtronic web site. I can't see the difference, it's still going over a cell phone. Oh wait thousands of dollars difference in software and equipment, multiplied by each company in service. Does make sense when the Medics are trained to read a 12 lead and the doc can meet them at the door for 30 seconds if he has a question.

LIFENET Blue provides EMS teams the ability to wirelessly transmit patient data from a LIFEPAK 12 defibrillator/monitor via a Bluetooth-enabled cell phone to a remote LIFENET RS Receiving Station in a hospital emergency department.

I wouldn't say what we use is Dinosaur it works.

Taxpayer money only goes so far.

Posted: **Mon Mar 30, 2009 7:12 am**

-SWS wrote: . . . I am of the opinion that he has saved lives on the message boards as well as in his daily work.

Thank you very much, SAG.

Ditto. Thanks for the often misread sense of humor, too, SAG.

And don't worry about that 401k. You've got a lot of good years ahead of you.

jeff

Posted: **Mon Mar 30, 2009 7:56 am**

I read some more and the software and you are talking about is not compatible with fire based EMS at least in Illinois. If we were to use the product you worked on we would have to do a few things. The first one is install the front end unit in every hospital we transport to because they will not, expecting a taxpayer funded fire department to do that is crazy. That software is also not compatible with the states required reporting system. Every EMS call has to have an EMS form completed and a fire report. The software we use and software other departments use dumps the info from the ePRC into the fire report so duplicate work isn't being done. Our fire reports are sent to the state after the software cleanses any Hipaa info from the report.
All our reports are sent to the state which also shares with the Federal government. Since the reorganization all fire departments now come under the juristiction of Homeland safety.

The equipment and software you talk about would work fine for a private ambulance provider or a hospital based Ambulance service not fire based.

We could not justify to the taxpayers having to pay our people to do double paperwork and provide that equipment for 6 pieces of fire equipment and 5 ambulances. Then purchase the equipment for nearly a dozen hospitals.

Posted: **Tue Mar 31, 2009 4:57 am**

OK, now we're getting somewhere!

I see three areas that you perceive as obstacles to upgrading your ECG transmission procedure and bring you into the Modern Era:

1. It's too costly.
2. It's too complicated.
3. It's too much work.

I will only be able to help you with two of those.

First of all, throw all this out because it has absolutely nothing to do with anything:

Gerryk wrote:I read some more and the software and you are talking about is not compatible with fire based EMS at least in Illinois. If we were to use the product you worked on we would have to do a few things. The first one is install the front end unit in every hospital we transport to because they will not, expecting a taxpayer funded fire department to do that is crazy. That software is also not compatible with the states required reporting system. Every EMS call has to have an EMS form completed and a fire report. The software we use and software other departments use dumps the info from the ePRC into the fire report so duplicate work isn't being done. Our fire reports are sent to the state after the software cleanses any Hipaa info from the report.
All our reports are sent to the state which also shares with the Federal government. Since the reorganization all fire departments now come under the juristiction of Homeland safety.

The equipment and software you talk about would work fine for a private ambulance provider or a hospital based Ambulance service not fire based.

We could not justify to the taxpayers having to pay our people to do double paperwork and provide that equipment for 6 pieces of fire equipment and 5 ambulances. Then purchase the equipment for nearly a dozen hospitals.

Next, review this list, and tell me who else besides Palos you transport to (I know, IL is a big state, but humor me here):

Code: Select all

Alton Memorial Hospital IL Alton 
Memorial Hospital IL Belleville 
Macneal Hospital IL Bewryn 
OSF St. Joseph Medical Center IL Bloomington 
St. Francis Hospital IL Blue Island 
Adventist Bolingbrook Hospital IL Bolingbrook 
Memorial Hospital of Carbondale IL Carbondale 
Advocate Trinity Hospital IL Chicago 
Mount Sinai Hospital IL Chicago 
Northwestern Memorial Hospital IL Chicago 
Our Lady of the Resurrection Medical Center IL Chicago 
Resurrection Medical Center IL Chicago 
Rush University Medical Center IL Chicago 
Saint Joseph Hospital IL Chicago 
Saints Mary and Elizabeth Medical Center IL Chicago 
The University of Chicago Hospital IL Chicago 
University of Illinois Medical Center IL Chicago 
Decatur Memorial Hospital IL Decatur 
Advocate Good Samaritan Hospital IL Downers Grove 
Sherman Hospital IL Elgin 
Alexian Brothers Medical Center IL Elk Grove Village 
Little Company of Mary Hospital and Health Care Centers IL Evergreen Park 
Evanston Hospital IL Evanston 
Adventist Glen Oaks Hospital IL Glendale 
Gateway Regional Medical Center IL Granite City 
Adventist Hinsdale Hospital   Hinsdale 
St. Alexius Medical Center IL Hoffman Estates 
Provena Saint Joseph Medical Center IL Joliet 
Silver Cross Hospital IL Joliet 
Rush Riverside Heart & Vasc. Ctr IL Kankakee 
Adventist La Grange Memorial Hospital IL La Grange 
Condell IL Libertyville 
Heartland Regional Medical Center IL Marion 
Loyola University Medical Center IL Maywood 
Northern Illinois Medical Center IL McHenry 
Good Samaritan Regional Health Center IL Mt. Vernon 
Edward Hospital IL Naperville 
Advocate Christ Medical Center IL Oak Lawn 
St. James Hospital and Health Centers IL Olympia Fields 
Palos Community Hospital IL Palos Heights  
Advocate Lutheran General IL Park Ridge 
OSF Saint Francis Medical Center IL Peoria 
Trinity Regional Health System IL Rock Island 
Rockford Memorial Hospital IL Rockford 
Swedish American Hospital IL Rockford 
Genesis Medical Center - Illini Campus IL Silvis 
Rush North Shore Medical Center IL Skokie 
Memorial Medical Center IL Springfield 
Prairie Cardiovascular IL Springfield 
St. John's Hospital IL Springfield 
Carle Foundation Hospital IL Urbana 
Vista Medical Center East IL Waukegan

SAG

Posted: **Wed Apr 01, 2009 5:26 am**

OK, to review:

1. When someone is having a myocardial infarction (heart attack), a blood vessel in the heart may become blocked. The sooner that blocked artery is cleared, the better the chance that person will escape serious heart damage and death.

2. Thus, the clock starts ticking from the moment of event onset to reopening of vessel.

3. The opening of the vessel is accomplished by inflating a tiny balloon at the end of a catheter (we'll talk about sucking out clots later).

4. A measure of the efficiency of a hospital to perform this procedure (Primary Angioplasty for Myocardial Infarction)(PAMI) for ST segment- Elevated Myocardial Infarction (STEMI)(boy, if you think sleep has a lot of acronyms, wait'll you get a load of this) is called the Door To Balloon Time (D2B)(the time from the moment the patient enters the ED to balloon inflation, and therefore, reperfusion). This target is 90 minutes.

5. Measuring ST elevation on ECG is critical to the entire process. It must be done quickly and accurately, and given to the person responsible for activating the PAMI Team ASAP, so, as previously noted, the patient goes directly (or at least with minimal delay) to the cath lab on admission.

6. Fax transmission of ECG results from the field is obsolete because they may be inaccurate (this from the manufacturer themselves), especially when it comes to being able to measure the subtle ST changes in an evolving AMI. Comparison to previous ECGs can be very helpful, as well as serial ECGs.

7. Therefore, transmission of the entire ECG data file (which is what happens with the Lifenet RS system) represents the current Standard of Care.

8. Not all hospitals perform PAMI, so if someone needs PAMI, that need has to be determined prior to transport in order to avoid a second transfer.

9. The above list of Illinois hospitals represents all those in the ACC D2B PAMI database, so it looks like Palos is the only one we have to worry about right now.

10. However, with a D2B <90 minute efficiency of only 71% at Palos, it looks like this project is going to take a lot more time than I thought.

11. It's not OFPD's responsibility to get the Lifenet RS package, it's Palos'. Hmmm, I wonder what they have now...

SAG

Posted: **Wed Apr 01, 2009 5:49 am**

-SWS wrote:Apparently he first petitioned for admission into the state of Illinois----but sadly never managed to produce the necessary Midwestern accent.

Midwestern accent, eh?

Of course I do, eh?

What's that aboot, eh?

SAG

Posted: **Fri Apr 03, 2009 5:20 am**

OK, this slide demonstrates why time is of the essence in accomplishing reperfusion in acute myocardial ischemia/infarction:

Reduction in mortality increases exponentially with time of reperfusion. Now, while the measure of a hospital's efficiency in PAMI is measured by door-to-balloon time (D2B), clearly, the factors prior to that measure are critical in determining overall outcome. These include:

Recognition of symptoms by patient
Activation of EMS
Response time of EMS
Time in field by EMS

So the real measure of increased survival% is time of insult to reperfusion. If the patient waits too long to activate EMS ("I can't be having a heart attack-- I exercised 10 years ago, only had 2 bacon-double cheeseburgers for lunch, and am only 50 pounds overweight because I am able to keep my weight down by smoking") or there is a delay in response or transport by EMS, then window of opportunity may be too severely compromised to expect a favorable outcome even with a good D2B Time.

SAG

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